3409 




c 



L L.- C I iM ^^ 



r^ . 






p-- ■■{■■ H Y 



^.-.3 i C_ K Nc: 



!<' J\/r— C 



^^'^^^'':5M^hVaT(M\ 






TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 

HUGH S. GUMMING, Surgeon General 



THE RELATION OF PHYSICAL DEFECTS 
TO SICKNESS 

A STUDY OF ABSENCE FROM SCHOOL ON ACCOUNT 

OF SICKNESS AMONG 3,786 CHILDREN IN FOUR 

LOCALITIES IN MISSOURI DURING THE 

SCHOOL SESSION 1920-1921 



BY 

SELWYN D. COLLINS 

Assistant Statistician 
United States Public Health Seriice 



REPRINT No. 782 

FROM THE 

PUBLIC HEALTH REPORTS 

September 8, 1922 

(Pages 2183-2193) 



^-Z-'Z-H 2.^ 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1922 



THE RELATION OF PHYSICAL DEFECTS TO SICKNESS. 

A STUDY OF ABSENCE FROM SCHOOL ON ACCOUNT OF SICKNESS AMONG 3,78fi 
CHILDREN IN FOUR LOCALITIES IN MISSOURI DURING THE SCHOOL SESSION 1920 21.' 

By SELWi-N D. Collins, Assistant Statistical!, United States Public Health Senice. 

A number of studies of morbidity among observed groups of people 
have been published in the past few years. These studies have 
shown that disability from sickness varies with sex and age, and the 
few studies which show disability by occupation show considerable 
variation as between occupations. A previous study ^ based on the 
observation of sickness among children during the school session 
1919-20, showed disability among children of different sex and age, 
regardless of the presence or absence of physical defects. It is the 
purpose of the present study to compare disability among children 
with certain common physical defects with disability among children 
with no physical defects, as measured by absence from school on 
account of sickness. 

In the course of a survey made in Missouri, school children were 
examined for physical defects, and certain physical measurements 
were made of them. On the same card on which the results of the 
examination were entered, the teacher kept a record of the absence 
of the child from school on account of sickness and from causes other 
than sickness. A group of 3,786 children from four fairly represent- 
ative localities in Missouri were observed during the school session 
1920-21, and the records tabulated for this study. The following 
table shows the four localities and the number of children observed 
in each. 

Table I. — Distribution according to locality of residence of 3,786 children in Missouri 
observed for sickness during the school session 1920-21. 



City. 



AH localities 

Hannibal 

Moberly 

Warrens burg. 
Joplin 



Marion 

Randolph. 
Johnson... 
Jasper 



Popu- 
lation 
of city, 
1920. 



19,306 
12,808 
4,811 
29,902 



Number 

of 
children 
observed. 



3,786 

1,378 

1,064 

682 

662 



1 From Field Investigations in Child Hygiene, United States Public Health Service, in cooperation with 
the Statistical Office, United States Public Health Service. Peprint from the Public Health Reports, 
vol. 37, No. 36, Sept. 8, 1922, pp. 2183-2193. 

3 CoUins, Selwyn D.: Sickness among school children. Public Health Reports, vol. 36, No. 27, pp. 1549- 
1559, July 8, 1921. (Reprint 674.) 

2 



12881—22 



LIBRARY OF CONGRESS 
.-. :«SCEIVEO 

N-bV23t922 



V 



^ \K% PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDREN. 



-V- 



The children ranged in age from 5 to 20 years, but very few were 
under 6 or over 16. The following table shows the distribution of 
the observed children according to sex and age. 

Table II. — Distribution according to sex and age of 3,786 children in Missouri observed 
for sickness during the school session 1920-21. 





Number. 


Per cent. 


Age last birthdaj' (years). 


Both 
sexes. 


Boys. 


Girls. 


Both 
sexes. 


Boys. 


Girls. 


All ages 


3,786 


1,891 


1,895 


100.0 


100.0 


100.0 






6 and under . . . 


4.30 
418 
420 

478 
427 


218 
200 
209 
239 
299 


212 
218 
211 
239 
198 
222 
213 
192 
109 
52 
29 


11.4 
11.0 
11.1 
12.6 
11.3 
11.3 
10.9 
9.9 
6.2 
3.0 
1.2 


11.5 
10.6 
11.1 
12.6 


11 2 


7 


11.5 


s 




9 


19" fi 


10 


12. 1 in 4 


11 


428 206 


10.9 
10.6 
9.7 
6.7 
3.3 
1.0 


11.7 


12 


414 
375 
235 
114 
47 


201 
183 
• 126 
62 
18 


11 2 


1.3 . .. . ... 


10 1 


14 


5.8 


1.5 


2.7 


16 and over 


1.5 







The data as reported by the teacher showed the total possible 
number of days the child could have attended school had he not 
been absent from some cause, the number of days on which the 
child was absent because of sickness, and the number of days absent 
from causes other than sickness. Sickness includes illness of any 
nature whatever. It is possible that some absence because of 
sickness may have been reported as due to causes other than sickness 
and that some absence from other causes may have been reported 
as due to sickness. It seems hardly probable, however, that the error 
was large enough to vitiate the results. 

The record of the child's physical examination showed what 
physical defects he had. The results of the hearing tests were 
reported so incompletely and imperfectly that no account was taken 
of hearing in any case; but all other physical defects were con- 
sidered. In tabulating the data, the children were divided into 
several classes according to physical condition. The following table 
shows the physical condition groups used, the number of children 
in each group, and the total days enrolled — that is, the total number 
of ''child days" for which records were kept: 



4 PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDEEN. 

Table III. — Distribution according to physical condition of 3,786 children (both sexes) 
, , . . in Missouri observed for sickness during the school session 1920-21. 



Physical condition. 



All phy ;iRal conditions 

Gi oupl: No recorded defects 

Group II: One or more decayed teeth only 

Group III: Defective vision (with and without decayed teeth) 

Group IV: Children with and ■without decayed teeth or defective -vision, but 
with no other recorded defects 

Group V: Enlarged or diseased tonsils only (with and without decayed teeth or 
defective vision) 

Group VI: Adenoids alone or associated with other defects; enlarged or diseased 
tonsils associated with other defects; mouth breathing alone or associated with 
other defects; chronic nasal catarrh alone or associated with other defects (with 
and without decayed teeth or defective \'ision) 

Group VII: Defects" other than those included in the above groups (with and 
without decayed teeth or defective vision) 



Number of 

children 
with speci- 
fied defects. 



3,786 
784 
545 
389 

2,283 

717 



571 
215 



Total pos- 
sible num- 
ber of days 
of school 

attendance. 



611,279 
132,995 
83,259 
57,382 

372, 755 

115,037 



90, 783 
32, 701 



Table IV shows the distribution according to age of the children 
in each physical-condition group. This table is included to show the 
extent of the data in the various age and physical-condition groups 
as an index of the reliability of the results. 

Table IV. — Number of children (both sexes) and the aggregate number of school days 
during ivhich they were under observation for sickness. 



Defect group." 



Total. 



II 



III 



IV 



VI 



VII 



NUMBER OF CHILDREN. 



6-7... 
8-9. . . 
10-11. 
12-13. 
14-16. 



3,786 


784 


545 


389 


848 


137 


94 


S7 


898 


190 


144 


77 


855 


181 


113 


77 


789 


168 


130 


89 


396 


108 


64 


59 



2,283 



534 
502 
482 
266 



717 


571 


154 


1.51 


189 


131 


172 


133 


140 


116 


62 


40 



215 

44 
44 
48 
51 
28 



TOTAL POSSIBLE NUMBER OF DAYS OF SCHOOL ATTENDANCE. 



All ages . 



6-7... 
8-9... 
10-11. 
12-13. 
14-16- 



611,279 


132,995 


83,259 


57,382 


372, 755 


115,037 


90,783 


137,482 


23,693 


14,018 


12,128 


81,925 


25,026 


23,940 


144,8:B1 


32,905 


21,489 


10,909 


87,381 


30, 163 


20,420 


139,310 


31,116 


17,216 


12,058 


83,364 


27,007 


21,467 


127,856 


28, 139 


20,590 


13,404 


78,166 


23,131 


18,785 


61,800 


17,142 


9,946 


8,883 


41,919 


9,710 


6,171 



a See Table III for definitions of the groups. 



32,704 

6,591 
6,876 
7,472 
7,774 
4,000 



The data on hearing were too incomplete to use; therefore all 
groups include children with defective hearing as well as normal 
hearing. 

Group I consists of children who had no recorded defects. 

Group II consists of children who had one or more decayed teeth, 
but no other recorded defects. 



PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDREN. 5 

Group III consists of children with defective vision with and 
without decayed teeth, but with no other defects. 

The small number of children made it impossible to subdivide 
them into as definite and clear-cut groups as would be desirable for a 
complete analysis. It was, therefore, necessary to disregard both 
teeth and vision in making the following defect groups, in order to 
have sufficient numbers of children in the groups to give dependable 
results. The effect of decayed teeth or defective vision on absence 
from school did not seem to be great. Also, unless the defects of 
teeth or vision were associated in some way with the other defects 
considered there would be no greater proportion of children with 
decayed teeth or defective vision in one defect group than in another 
or in the group who had no general defects when teeth and vision 
were not taken into account. (Group IV.) 

Group IV consists of children with and without decayed teeth or 
defective vision, but with no other recorded defects. 

Group V consists of children with and without decayed teeth and 
defective vision who had enlarged or diseased tonsils, but no other 
recorded defects. 

Group VI consists of children with and without decayed teeth and 
defective vision, but who had adenoids alone or associated with other 
defects; enlarged or diseased tonsils associated with other defects; 
mouth breathing alone or associated with other defects; chronic 
nasal catarrh alone or associated with other defects. 

Group VII consists of all children with and without decayed teeth 
or defective vision and with defects other than those included in the 
above groups. 

Since the children could not be divided into groups according to 
specific defects, but had to be sorted according to groups of defects. 
Table V is introduced to show the number of specific defects included 
in each of the groups who had defects other than decayed teeth or 
defective vision. 



Table V. 



-Number of children in each of the physical condition groups loho had certain 
specific defects. 



Defect. 



All physical 
conditions. 


Number of defects in 
group, a 


each 


Defects 
per 1,000 
children. 


Number 

of 
children. 


IV. 


v. 


VI. 


VIl. 


1,000.0 
603.0 


3,786 

2,283 
360 
185 
23 
16 
],038 
77 


2,283 
2,283 


717 


571 


215 


95.1 




360 

185 
23 
16 

325 
41 




48.9 








6.1 




• 




4.2 








274.2 
20.3 




713 
36 





Total number of cliildren 

No general defects (teeth and vision not taken 

account of) 

Mouth breathing 

Adenoids , 

Chronic nasal catarrh , 

Deflected septum or other nasal obstruction , 

Enlarged tonsils or infected throat 

Diseased or inflamed tonsUs 

o See Table III for definitions of the groups. 
12881—22 2 



6 PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDREN. 

Table V. — Number of children in each of the physical condition groups who had certain 
specific defects — Continued. 



Defect. 



All physical 
conditions. 



Defects 
per 1,000 
children. 



Number 

of 
children. 



Number of defects in each 
group. 



IV. 



VI. 



Ear discharging 

Ear drum perforated 

Ear drum obscured by wax 

Hyperopia 

Astigmatism 

Strabismus 

Blepharitis 

Conjunctivitis 

Trachoma 

Glandular enlargement, cervical 

Simple goiter 

Hernia 

Heart defects 

Tuberculosis or pretubercular 

Anemia 

Winged scapulae 

Spinal curvature 

Deformity of hand or arm 

Deformity of foot or leg 

Paralysis, infantile 

Retarded 

Feeble minded or suspected 

Speech defect 

Ringworm 

Pediculosis 

Impetigo 

Scaoies 

Eczema 

Skin defect (not otherwise specified) 

Orthopedic defect (not otherwise specified) 

Glandular enlargement (not otherwise specified).. 

Ear defect (not otherwise specified) 

Eye defect (not otherwise specified) 

Miscellaneous 



2.6 
.3 

3.4 

4.5 
.3 

2.1 
14.8 



8.5 
3.7 



.5 

.3 

1.1 

1.3 

1.8 

.5 

.5 

.8 

10.8 

.5 

13.5 

1.6 

2.1 

.3 

30.4 

.3 

.3 

.3 

. 5 

5.5 



1 
115 
1 
1 
1 



The children observed have now been classified into the various 
groups and the groups have been defined. The next step in the 
study is the comparison of the absence on account of sickness among 
the children in these various groups, that is, the comparison of the 
absence on account of sickness among children with no defects with 
absence among children with the various specified groups of physical 
defects. The following table (Table VI) shows, by sex, age, and 
physical condition, the percentage of the total school days which 
were lost on account of sickness and of causes other than sicknes .^ 

Figures 1 and 2 compare graphically the time lost from sickness 
by children with various physical defects. Figure 1 compares the 
averages for all ages, and Figure 2 makes the comparison by age 
groups. Sickness in each case is not limited to sickness directly 
connected with the defect, but includes all illness from any cause 
whatever. 



•If a child was permanently separated from school he was no longer counted as enrolled. In the case 
of absences for short periods, the total time absent was counted rather than drop the child from the roll 
and reenter him upon return, as is sometimes done in keeping school records. Obviously, the record 
desired was the total time absent because of sickness. 



PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDKEN. 7 

Table VI. — Physical defects and absence from school on account of sickness. 

Percentage of the total school days which were lost by children with no defects compared with children 
with various physical defects. 

[3,786 children in Missouri— School session 1920-21.] 



Physical condition. 



All 

ages. 



Age. 



BOTH SEXES. 



All physical conditions 

Group I: No recorded defects , 

Group II: One or more decayed teeth only , 

Group III: Defective vision 

Group IV: With and without defective teeth or vision 
but with no other defects 

Groups V-VII: Defects of any kind 

Group V: Enlarged or diseased tonsils only 

Group VI: Adenoids alone and adenoids, tonsils, etc., 
associated with other defects 

Groups V-VI: Adenoids, tonsils, etc^ alone or asso- 
ciated with other defects 

Group VII: All other defects 



3.5 


4.9 


3.5 


3.0 


2.9 


3.2 


4.5 


3.5 


2.8 


2.7 


3.3 


4.7 


3.5 


2.7 


3.0 


3.5 


3.3 


3.5 


3.8 


3.8 


3.2 


4.7 


3.2 


2.6 


2.8 


3.9 


5.2 


4.0 


3.5 


3.1 


3.6 


4.5 


3.9 


3.4 


2.9 


4.2 


5.9 


4.0 


3.9 


3.2 


3.9 


5.2 


3.9 


3.6 


3.0 


4.0 


5.3 


4.5 


3.0 


3.1 



2.3 

1.9 
2.3 
2.8 

2.1 
2.8 
2.5 

2.2 

2.4 
4.6 



All physical condit ions 

Group I: No recorded defects 

Group II: One or more decayed teeth only , 

Group III: Defective vision , 

Group IV: With and without defective teeth or vision 
but with no other defects 

Groups V-VII: Defects of any kind 

Group V: Enlarged or diseased tonsils only 

Group VI: Adenoids alone and adenoids, tonsils, etc., 
associated with other defects 

Groups V-VI: Adenoids, tonsils, etc., alone or asso- 
ciated with other defects 

Group VII: AU other defects 



3.3 


6.0 


3.2 


2.8 


2.8 


3.2 


4.4 


3.5 


3.2 


2.9 


3.3 


3.8 


3.6 


3.0 


3.1 


2.6 


3.0 


2.2 


2.9 


2.0 


3.1 


4.7 


3.0 


2.6 


2.5 


3.7 


5.4 


3.5 


3.2 


3.2 


3.6 


4.7 


3.8 


3.1 


3.5 


3.8 


5.7 


3.3 


3.5 


2.9 


3.7 


5.3 


3.5 


3.3 


3.2 


3.9 


6.4 


3.5 


2.3 


3.2 



2.3 
1.7 
3.2 
3.1 

2.2 
2.4 
1.9 



2.1 
4.3 



All physical conditions , 

Group I: No recorded defects 

Group II: One or more decayed teeth only , 

Group III: Defective vision , 

Group IV: With and without defective teeth or vision 
but with no other defects , 

Groups V-VII: Defects of any kind 

Group V: Enlarged or diseased tonsils only 

Group VI: Adenoids alone and adenoids, tonsils, etc., 
associated with other defects 

Groups V-VI: Adenoids, tonsils, etc., alone or asso- 
ciated with other defects 

Group VII: AU other defects 



3.6 


4.8 


3.9 


3.2 


3.1 


3.1 


4.7 


3.5 


2.5 


2.6 


3.2 


5.6 


3.4 


2.4 


2.9 


4.1 


3.5 


4.4 


4.2 


5.1 


3.4 


4.7 


3.5 


2.7 


3.1 


4.0 


5.0 


4.5 


4.0 


2.9 


3.6 


4.4 


3.9 


3.6 


2.4 


4.7 


6.1 


5.3 


4.5 


3.7 


4.0 


5.1 


4.3 


4.0 


2.9 


4.1 


3.4 


5.7 


4.0 


3.0 



2.4 

2.2 

.8 

2.6 

2.0 
3.2 
3.0 



2.7 
4.7 



See Table III for detailed definitions of groups. 

Figure 1 compares absence among children (all ages) with no 
defects with children with various groups of defects. Children with 
no defects were absent 3.2 per cent of the school days as against 3.9 
per cent by children with defects of any kind. Considering these 
percentages as rates (days absent per 100 days enrolled), the rate of 
absence from sickness for children with defects is 22 per cent greater 
than the rate for children with no defects. The rate of absence from 



8 PHYSICAI^ DEFECTS AND SICKNESS IN SCHOOL CHILDREN. 

sickness for children with enlarged or diseased tonsils is 12 per cent 
greater than the no-defect rate, and the rate for children with adenoids, 
defective tonsils, etc., associated with other defects, is 31 per cent 
greater than the rate for the children with no defects. The rate for 
children with defective vision was 9 per cent greater and the rate for 
children with decayed teeth was 3 per cent greater than the no- 
defect rate. 

Figure 2 takes up the rates in the various age groups and shows what 
differences are consistent for the different ages. It shows for five age 
groups for both sexes combined the percentage of the total school 



PHYSICAL DETECTS AMD ABSENCE TEoM School OM ACCOUNT OF SIClCNESS 

,R5.rc.e.nt.age. of tWe Total School Pavs vwhioW were Los"t 
b^ Children (ad nges) with No Defects comp-ared wi"tK 
Childrei-i vAdtVi Various. Physical De-fects ~ 



Physical Coadition 



F« rc«n t . 
Z 3 



X Ho defect a 

II Dacayed toeth only 

III Defective Tlslon 
lY No g«n«ral defect* 

V-VII Defects of any kind 

V Snlarged or diseased tonsils 
only 

71 Adenoids or tonsils associa- 
ted with other defects 
7-71 Adenoids or tonsils alone oi^ 
with other defects 

7X1 All other defects 



Fig. 1. 
See Tatle III for detailed definitions of groups. 

days which were lost on account of sickness by children in the various 
physical conditions. In each small graph in the figure, the curve of 
sickness for children with no physical defects (Group I) is repeated 
so that a comparison can more readily be made between this group 
and each of the other groups. Graph A compares children with no 
defects (Group I) with those who have some general physical defect 
(Groups V to VII inclusive). The differences are considerable and 
are consistent in the various age groups. 

Graph B compares children with no defects with children who have 
decayed teeth and with children who have defective vision. In 
neither case are the differences consistent for the various age groups. 
Vision appears to have some influence; but with the few data avail- 
able no very definite conclusion can be drawn unless the results are 
consistent for the various ages. It is possible that the effect of 
certain defects might be shown to be greater at certain ages than at 
others if there were sufficient data. 



PHYSICAL DEFECTS AISTD SICK]s:ESS IIST SCHOOL CHILDREN. 



9 



In the two lower graphs, the children with no defects (Group I), 
are compared with a group with enlarged or diseased tonsils or both 
(Group V) and with another group who have adenoids alone or 



PHYSICAL DEFECTS ANP ABSENCE FJSOM SCHOOL 
ON ACCOUNT OT SICK.NESS 

Ffercentoge o-F the. Totol ScHooI Pa>fS which vvere- Lost, h-j Ch'iidr&r, 
(BotVi Se.xes3 vvltl-i No De.-(ecis Compored vm'i±.K CKiUre-n 
w/ifcli Var«ou.s Physical Pe-Pec-ts 
3,7et. Ch'.ldre-r. iv. Missoii-r. - ScViccI Session l<=?ao-2,l 



AGE GEOURS 
fo-7 8-1 10- II l^-l'5 




i-n 



AGE- GROUPS 
8-<1 lo-il Ii-I3 



+ 
Gr. T- Nc. d*.?t^t,=, 

Or. Il-Dfica;ja<i tte-tl-, ov 

Gr. m- De-f«.=.iwe. visior. 



5 -- 



--fe 



-- 5 



c 





s -- 




-- 2 



-- I 



Gr I- No de?e.ol-& 
■ Gr.y-YI - Adsnoids or tonarl* 
alone, or wl-Wn •■tK«r 




-«rl ■ 



No defects 

, Gr.TT- To»,til& OTil^ 

*, Gf.ttC-A<4<E»^o;A.s or ^0- 

\ pW* Sorrte oTKer <i« 



•■feet 




--3 



T.-^. Z,. 
S<s& Table. HI -For <leiailed de-fi-nitions o-f jfroii-ps.. 

associated with other defects, defective tonsils associated with other 
defects, mouth breathing and chronic nasal catarrh alone or asso- 
ciated with other defects (Group VI). Graph D shows each group 
separately and graph C shows the two groups combined. The group 
with defective tonsils only (Group V) lost more time at every age 
group except 6-7 years than the group with no physical defects 
(Group I). The group with adenoids, defective tonsils, etc., asso- 



10 



PHYSICAL DP:FECTS AND SICKNESS IN" SCHOOL CHILDREN, 



ciated with other defects (Group VI) lost considerably more time at 
every age group than the no-defect group (Group I) and also more 
time than the group with defective tonsils only (Group V) in every 
age group except 14-16 years. 

The records also showed the time lost from school from causes other 
than sickness. Table VII shows by sex and age groups the absence 
from causes other than sickness for each of the physical-condition 
groups used in tabulating the absence from sickness. Figure 3 com- 
pares, for all ages combined, the time lost from causes other than 
sickness, by children with no defects, with the time lost by children 
with the various physical defects. 



PHYS/CAL PETECTS AUP ABSENCE fROM SCHOOL. ^I^oM CAUSES 
OTHEe THAN SICKNESS 

Pe<-cen-tage of the Total Sc>iool Oa-jS whicK were. Lost 
b'^ Children (all ages) s»/.th No Pefects corripared »wi-tli 
CVi;idrer, w'.iK VarloKjs Physical Pe-fects 



Physical Condition. 




I No defects 

II Decayed teetb only 

III DefectlTe vision 

IV Ko general defects 

Y-VII Defects of any tind 

7 Bnlargud or diseases tonsils 

only 
VI Adenoids or tonsils associa- 
ted with other defects 
V~VI Adenoids or tonsils alone or 
with other defects 
VII All other defects 



~ Fig. 3. 

See Table III for detailed definitions of groups. 

Table VII. — Physical defects and absence from school from causes other than sickness. 

Percentage of total school days which were lost by children with no defects compared with children with 

various physical defects. 

[3,786 children in Missouri— School session 1920-21.] 



Physical condition. 



Age. 



All 



6-7 



8-9 



10-11 I 12-13 14-16 



BOTH SEXES. 



All physical conditions 

Group I: No recorded defects 

Group II: One or more decayed teeth only 

Group III: Defective vision 

Group IV: With and without defective teeth or vision 
but with no other defects 

Groups V-VII: Defects of any kind 

Group V: Enlarged or diseased tonsils only 

Group VI: Adenoids alone and adenoids, tonsils, etc., 
associated with other defects 

Groups V-VI: Adenoids, tonsils, etc., alone or asso- 
ciated with other defects 

Group VII: AH other defects 



2.5 


2.9 


1.8 


1.5 ! 


2.4 


3.0 


2.5 


4.1 


2.3 


2.6 


2.8 


3.4 1 


2.8 


3.5 


2.5 


3.2 


2.7 


3.3 ■ 


:?.3 


3.5 



2.1 


1.9 


2.6 


1.7 


1.6 


1.8 


2.0 


1.7 


2.3 


2.5 


1.8 


1.8 


2.0 


1.7 


2.5 


2.2 


2.3 


2.7 


2.3 


2.1 


2.6 


1.6 


2.2 


2.7 


2.0 


2.2 


2.7 


3.9 


2.9 


3.0 



3.6 
.3.0 
4. 1 
2.5 

.3.4 
4.2 
4.9 



4.4 
3.5 



PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDEEN. 



11 



Table VII. — Physical defects and absence from school from causes other than sickness — Con. 

Percentage of total school days which were lost by children with no defects compared with children with 

various physical defects. 



Physical condition. 



All 



8-9 



12-13 



All physical conditions 

Group I: No recorded defects 

Group II: One or more decayed teeth only 

Group III: Defective vision 

Group IV: With and without defective teeth or vision 
but with no other defects 

Groups V-VII: Defects of any kind 

Group V: Enlarged or diseased tonsils only 

Group VI: Adenoids alone and adenoids, tonsils, etc., 
associated with other defects 

Groups V-VI: Adenoids, tonsils, etc., alone or asso- 
ciated with other defects 

Group VII: All other defects 



2.7 


3.3 


2.2 


2.1 


2.7 


1.9 


1.8 


1.5 


1.6 


1.9 


2.5 


3.0 


1.8 


1.8 


2.4 


2.9 


4.0 


3.6 


1.9 


1.9 


2.5 


2.9 


2.1 


1.8 


2.5 


3.1 


3.9 


2.5 


2.4 


3.0 


3.3 


4.2 


2.7 


2.2 


3.2 


2.6 


3.9 


1.4 


2.4 


2.5 


3.0 


4.0 


2.1 


2.3 


2.8 


3.8 


3.2 


5.0 


3.4 


4.0 



4.1 
3.3 
4.5 
2.7 

3.7 
5.0 
6.2 

4.0 

5.3 
3.4 



All physical conditions 

Group I: No recorded defects 

Group II: One or more decayed teeth only 

Group III: Defective vision 

Group IV: With and without defective teeth or vision 
but with no other defects 

Groups V-VII: Defects of any kind 

Group V: Enlarged or diseased tonsils only 

Group VI: Adenoids alone and adenoids, tonsils, etc., 
associated with other defects 

Groups V-VI: Adenoids, tonsils, etc., alone or asso- 
ciated with other defects 

Group VII: All other defects 



2.2 


2.5 


1.9 


1.8 


2.4 


1.7 


1.1 


1.8 


1.5 


1.8 


2.4 


3.0 


2.2 


1.6 


2.2 


2.3 


4.2 


1.6 


1.7 


1.8 


2.1 


2.3 


1.9 


1.7 


2.4 


2.4 


2.8 


2.0 


2.1 


2.5 


2.4 


2.9 


2.0 


2.1 


2.2 


2.4 


2.4 


1.9 


2.0 


3.1 


2.4 


2.7 


1.9 


2.0 


2.5 


2.8 


4.0 


2.5 


2.4 


2.1 



3.1 

2.8 
3.5 
2.4 

2.9 
3.5 
3.6 

3.2 

3.4 
3.6 



See Table III for detailed definitions of groups. 

For some reason, absence from causes other than sickness also 
varies in the different physical-condition groups. Those groups with 
defects were absent more than the group with no defects. Part of 
this difference may be due to incorrect reporting of the causes of 
absence, but it seems unlikely that it could all be due to such causes. 

Summary. 

1. Records of physical examination and school attendance during 
the school session 1920-21 were kept for 3,786 children in four fairly 
representative localities in Missouri. 

2. These children were classified according to physical condition, 
and the absences from sickness and from causes other than sickness 
were compared by age groups for children of different physical con- 
ditions. 

3. Children with no defects were absent from school on account of 
sickness consistently less than those with defects. 

Children with enlarged or diseased tonsils were absent more than 
children with no defects, and those with enlarged or diseased adenoids 



12 PHYSICAL DEFECTS AND SICKNESS IN SCHOOL CHILDEEN. 

or tonsils associated with other defects were absent considerably 
more than those with enlarged or diseased tonsils only. 

Decayed teeth showed little or no effect on absence, and defective 
vision failed to show a consistent effect on absence from school on 
account of sickness. 

4. Absence from causes other than sickness showed variations some- 
what similar to absence from sickness; the groups with defects were 
absent more than the group with no defects. 



ADDITIONAL COPIES 

OF THIS PUBLICATION MAY BE PROCURED FROM 

THE SUPERINTENDENT OF DOCUMENTS 

GOVERNMENT PRINTING OFFICE 

WASHINGTON, D. C. 

AT 

5 CENTS PER COPY 



A 



